What Should You Know About Phlebitis?

Picture of an vein inflamed with phlebitis.
Picture of an vein inflamed with phlebitis.

What Is the Medical Definition of Phlebitis?

Phlebitis (fle-BYE-tis) is a condition in which a vein becomes inflamed (phleb=vein + it is=inflammation). The inflammation may cause pain and swelling. When the inflammation is caused by a blood clot or thrombus, it is called thrombophlebitis. Thrombophlebitis usually occurs in leg veins, but it may also affect the veins in the arms.

What Are Phlebitis Symptoms?

Some people with phlebitis have no symptoms, but others may experience signs like pain, tenderness, redness, and a bulging vein.

What Causes Phlebitis?

Phlebitis can be caused by many things, for example, sitting to long on long drives, train or plane rides, varicose veins, some cancers, and after surgery.

What Are the Types of Phlebitis?

There are two sets of veins in the arms and legs, 1) the superficial veins that run just under the skin, and 2) the deep veins. Superficial phlebitis affects veins on the skin surface. The condition is rarely serious and usually resolves with local treatment of the inflammation with warm compresses and anti-inflammatory medications. Sometimes superficial phlebitis can be associated with deep vein thrombophlebitis and medical evaluation may be needed. Phlebitis in the deep veins is referred to as deep vein thrombophlebitis (or DVT, deep vein thrombosis) affects the veins located deeper in the arms and legs. Blood clots (thrombi) that form may embolize or break off and travel to the lungs. This is a potentially life-threatening condition called pulmonary embolism.

What Is the Treatment for Phlebitis?

Doctors treat phlebitis based on what condition is causing it.

What Are the Symptoms and Signs of Superficial Phlebitis and DVT?

Superficial phlebitis

  • There is usually a slow onset of a tender red area along the superficial veins on the skin. A long, thin red area may be seen as the inflammation follows the path of the superficial vein. It may spread in a spider like pattern if smaller feeder veins become involved.
  • This area may feel hard, warm, and tender. The skin around the vein may be itchy and swollen.
  • The area may begin to throb or burn.
  • Symptoms may be worse when the leg is lowered, especially when first getting out of bed in the morning.
  • A low-grade fever may occur.
  • Sometimes phlebitis may occur at the site where a peripheral intravenous (IV) line was started. The surrounding area may be sore and tender along the vein.
  • If an infection is present, symptoms may include redness, fever, pain, swelling, or breakdown of the skin.

Deep vein thrombophlebitis

The classic signs and symptoms include redness, warmth, swelling, and pain in the affected extremity. Often one extremity is more swollen than the other. Occasionally the discoloration may be more bluish than red.

What Causes Phlebitis?

Superficial phlebitis is usually caused by local trauma to a vein. Superficial phlebitis is most often caused by an intravenous catheter (IV) placed in a vein, and the vein becomes irritated. Superficial phlebitis may or not have a blood clot form to cause the pain and inflammation. In the legs, superficial phlebitis can be associated with varicose veins.

Causes of deep vein thrombosis or thrombophlebitis include:

  • inactivity (blood pools in the veins and tends to clot if a person is inactive for a prolonged period of time);
  • trauma, and
  • blood clotting abnormalities (may be inherited).

Risk factors for DVT include:

  • Prolonged inactivity (for example, a long airplane or car ride, an extremity immobilized in a cast or splint, being bedridden for an illness or after surgery, a sedentary lifestyle, inactivity with little or no exercise)
  • Obesity
  • Smoking cigarettes, especially when combined with hormone replacement therapy or birth control pills
  • During pregnancy, the enlarged uterus can also compress the large veins in the pelvis increasing the risk of blood clotting.
  • Certain medical conditions such as cancer or blood disorders that increase the potential of blood clotting
  • Injury to the arms or legs

When Should You Call a Doctor for Phlebitis?

Call your doctor if there is swelling or pain in an extremity. Especially, if there are risk factors for deep vein thrombophlebitis including prolonged travel, bed rest, or recent surgery.

Deep vein thrombophlebitis requires immediate medical care, especially if you have any of these signs and symptoms:

  • High fever with any symptoms in an arm or leg
  • Lumps in a leg
  • Severe pain and swelling in an arm or leg
  • Chest pain and shortness of breath, which could be the symptoms of pulmonary embolism (blood clot in the lung).

How Do You Know if You Have Phlebitis?

A healthcare professional will ask you questions about your swollen arm or leg and will give you a physical exam. If the diagnosis is superficial phlebitis, often no further tests are necessary. If there is concern about deep vein thrombosis (DVT), further tests may be ordered.

  • D-Dimer is a chemical that is released by blood clots as they begin to disintegrate. If this blood test is normal, then a blood clot is not present. Unfortunately, the test does not tell the doctor the location where a blood clot might be. For instance, it will be positive in people with a bruise or those who have recently had surgery. This blood test needs to be ordered only when there is a low risk of DVT being present. A positive test usually requires that some imaging test of the arm or leg be ordered to look for a potential blood clot.
  • Ultrasound can detect clots or blockage of blood flow, especially in larger, more proximal (upper leg) veins. A small hand-held instrument (probe) is pressed against the patient's skin to help identify blood clots and the location of the obstruction. This is a non-invasive test which is relatively painless.
  • Sometimes the ultrasound test cannot adequately "see" the veins and determine whether a clot is present. Venography may be required in which dye is injected directly into the vein and X-rays are taken to evaluate the vein.

Can You Treat Phlebitis at Home?

The pain from superficial phlebitis can be treated at home by applying a warm compress to the affected area, and taking nonsteroidal anti-inflammatory pain relievers (NSAIDs) like ibuprofen (Motrin, Advil), naproxen (Aleve, Anaprox, Naproxen), and aspirin to prevent a blood clot in the leg. Prescription leg compression stockings (knee or thigh high) improve blood flow and may help to relieve pain and swelling, and decrease the risk of developing DVT.

What Is the Treatment for Phlebitis?

Treatment for superficial phlebitis includes warm compresses and anti-inflammatory medications such as ibuprofen. Compression stockings may be helpful. If there is a skin infection associated with the superficial phlebitis, antibiotics may be prescribed.

Treatment for deep vein thrombophlebitis are blood thinning drugs to prevent pulmonary embolism. Initial treatment may begin with enoxaparin (Lovenox), an injectable medication that immediately thins the blood. Warfarin (Coumadin) is also started immediately but takes a few days to reach therapeutic levels in the blood, so Lovenox is used as a bridge until that occurs. INR is a blood test that measures the clotting function of blood and is used as a guide to determine warfarin dosing.

Are Superficial Phlebitis or DVT Life-Threatening?

Superficial phlebitis is rarely serious and usually responds to pain control, elevation, and warm compresses.

Deep vein thromboembolism is potentially life-threatening if not treated, pulmonary embolism is a potential complication. It is important to find out why the DVT occurred and minimize the risk factors for a future occurrence. DVT can damage the internal structure of the vein leading to the complication of a post-phlebitic leg with chronic leg swelling and pain.

What Can You Do to Prevent Phlebitis or DVT?

The best way to prevent phlebitis is to be active. Participate in daily exercise such as walking, swimming, jogging, cycling, dance classes, etc. Avoid prolonged periods of sitting or lying down (if possible). Avoid bed rest for prolonged periods.

If you are limited to bed rest, wear supportive stockings. When traveling and movement is limited for long periods of time, get up and move around occasionally or stop at a rest stop and move around. Keep hydrated and drink plenty of fluids. Changing of IV lines will help prevent phlebitis.

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DVT (Blood Clot in the Leg)

Phlebitis in the deep veins

Deep venous thrombosis (DVT) refers to a blood clot embedded in one of the major deep veins of the lower legs, thighs, or pelvis. A clot blocks blood circulation through these veins, which carry blood from the lower body back to the heart. The blockage can cause acute pain, swelling, or warmth in the affected leg. Blood clots in the veins can cause inflammation (irritation) called thrombophlebitis.

Fauci, AS, et al. Harrison's Principles of Internal Medicine, 20th Ed. United States: McGraw-Hill Education, 2018.